Cardiovascular disease, abbreviated as CVD, is an intricate group of heart-related conditions which are considered to be the top cause of death among Americans and Europeans. Unfortunately, the prevalence of cardiovascular disease is increasing rapidly in developing nations as well. Therefore, finding safe and effective strategies to treat and prevent cardiovascular disease, or CVD, has become a significant priority around the globe.
What are some safe and effective treatment strategies for cardiovascular disease?
Many factors contribute to the development of cardiovascular disease, which involve high blood pressure, coronary artery disease, heart failure, stroke, and congenital cardiovascular defects. Epidemiological studies investigating CVD risk factors have pointed to the role of elevated serum lipids (including cholesterol and triglycerides), elevated blood pressure, or BP, increased platelet aggregation, increased plasma fibrinogen and coagulation factors, alterations in glucose metabolism, as well as smoking. Reduced risk of CVD is associated with increased serum levels of high-density lipoprotein (HDL-C), normalization of abnormal lipid levels, inhibition of platelet aggregation, and increased antioxidant status, according to some research studies.
While these various factors have been determined to lead to cardiovascular disease, dietary factors have been known to play a major role in CVD, where Mediterranean diets, fish, fruit, and whole grains have also been proven to reduce CVD risk. One research study where patients admitted with severe cardiovascular disease were interviewed, found that 78 percent were using natural health products; such utilization was recorded by pharmacists in 41 percent of patients, by doctors in 22 percent and by nurses in 19 percent. Among all the natural health products used to treat cardiovascular disease, garlic (Allium sativa, Family Liliaceae) has been in the top five best selling herbs, and is the most popular herb used by patients with CVD.
Garlic has been a significant element in many cultures for centuries. Ancient Ayurvedic texts consult health benefits of garlic concerning improving blood circulation and strengthening the heart. The Egyptian Codex Ebers (1500 BC) recommended garlic for heart disease, and also for tumors, worms and a number of other conditions. The Greek physician, Hippocrates (400 BC), along with the Roman authority, Pliny the Elder (77 AD), recommended garlic for the cardiovascular system. Clinical work as early as 1926 found garlic to have beneficial effects on cardiovascular disease. These effects were again mentioned in the 1960’s and 1970’s when numerous studies noted a decrease in serum cholesterol and triglyceride levels. However, these early studies were conducted using raw garlic administered at very high doses (between seven and 28 cloves per day).
Garlic’s odor problem has led to much work being done to find more palatable and less odorous formulations. The odor, as well as garlic’s cardiovascular effects, is caused by sulfur-containing compounds. Garlic cloves contain nearly all their sulfur at a storage compound called alliin (a name coming from garlic’s botanical name, Allium sativum). Raw garlic also contains an enzyme known as alliinase. When raw garlic is crushed or cut, the alliinase interacts with alliin to make allicin. The distinctive aroma and flavor of garlic is a result of allicin, which is very volatile and unstable, breaking down either in a couple of hours at room temperature or after a few minutes of cooking. An in vitro study found that garlic’s ability to inhibit platelet aggregation wasn’t changed after 3 minutes or less of immersion. After 6 minutes, cloves had no action, whereas some activity was retained by crushed garlic. After 10 minutes, all activity was gone. By microwaving for approximately 2 minutes, all activity was removed from many samples.
As allicin breaks down or is metabolized, dozens of other more stable sulfur compounds are formed. A number of them are active. Allicin is converted into polysulfides and ajoene which could be stable for over a year, when garlic is macerated with oil. However, each compound’s precise action remains uncertain. Most regard the sulfur-containing compounds as crucial to the health benefits of garlic, although those compounds are also responsible for garlic’s odor-problems. The ways garlic has been processed direct to preparations with various compounds, which might be inconsistent.
Mechanism of Action
In spite of considerable numbers of in vitro research, the component(s) in garlic accountable for its cardiovascular effects remain unclear. Garlic impacts the cardiovascular system via several mechanisms, but a lot of its constituents are biologically active and uncertainty remains about the way they all interact. Ajoene and other compounds inhibit platelet aggregation, which can help prevent cardiovascular disease, or CVD. Allicin has antiplatelet aggregating activity, even though its instability makes it difficult to fully study its clinical effects. Several garlic components inhibit liver enzymes involved in making cholesterol, such as HMG-CoA reductase (the enzyme inhibited by statins), and many others reduced plasma cholesterol and triglyceride levels through unclear mechanisms of activity. Garlic also contains antioxidants that could counteract the development of atherosclerosis. Components cause muscle relaxation, which could contribute to decreased hypertension, a common issue along with cardiovascular disease.
Various sulfur compounds derived from garlic trigger the release of hydrogen sulfide (H2S) from human red blood cells. H2S, naturally occurring cell signaling molecule, provides protection against oxidative damage, including smooth muscle relaxation, and decreased blood pressure. This new research might lead to a means of standardizing preparations, and sheds light on the potential mechanisms of action of garlic.
Many laboratory and animal tests have demonstrated that garlic and its components have biological activities related to cardiovascular disease; nonetheless, controversy continues over the clinical significance of these findings. Results of trials have been conflicting, with early studies frequently finding beneficial effects that were not replicated in more recent trials which were usually of higher methodological quality. The impact of garlic intake or supplementation on serum cholesterol and lipid levels has received the most research.
Two meta-analyses published in 1993 and 1996 generated curiosity about garlic because they reported 9 percent and 12 percent reductions in total cholesterol levels. More recent meta-analyses have come to various conclusions; one printed in 2009 concluded that there was no evidence from randomized controlled trial (RCTs) of garlic with any favorable effects on serum cholesterol. However, the research in that meta-analysis was criticized for not being comprehensive. The latest evaluation analyzed literature published up to October 2011 – 12 and contained 26 RCTs reporting the effects of garlic on various serum lipids. In general, garlic considerably reduced serum total cholesterol from 0.28 mmol/L (P = 0.001) and triglycerides by 0.13 mmol/L (P < 0.001). At the exact same time, no significant differences were found for low-density lipoprotein cholesterol (LDL-C), HDL-C, apolipoprotein B, and overall cholesterol/HDL-C ratio. The reviewers calculated that the substantial differences were equal to a 5.4 percent decrease in total cholesterol levels to someone with a baseline amount of 5 mmol/L and a 6.5 percent reduction in triglyceride levels for somebody starting with a 2 mmol/L level. The daily doses most widely utilized in the studies reviewed were 10 to 15 mg garlic oil, 900 mg garlic powder, and 1 to 7 g aged garlic extract. Study duration ranged from two weeks to 12 months, with the majority of trials lasting 3 or 6 months.
Many studies have analyzed the role of garlic aids in lowering blood pressure. A 1994 meta-analysis of 10 randomized, controlled trials reported an overall significant reduction in systolic and diastolic blood pressure of 5 and 8 mmHg. Another meta-analysis published in 2008 comprised 11 RCTs and reported a general decrease of 4.56 mmHg in systolic blood pressure for people taking garlic (P < 0.001). Diastolic blood pressure did not change significantly compared to placebo. There was a planned sub-group analysis conducted comparing those who were normotensive or hypertensive . The hypertensive subgroup had considerable reductions of 8.4 and 7.3 mmHg for systolic and diastolic blood pressures, respectively. Substantial reductions were not shown by the subgroup that is normotensive. The reviewers noted that discounts of 4 to 5 mmHg systolic and 2 to 3 mmHg diastolic are held to be important. At precisely the exact same time, some RCTs have found no significant differences between classes carrying placebo and garlic.
Although a lot of garlic elements have demonstrated antioxidant properties, comparatively few studies are done on the clinical importance of the effects. Another product called aged garlic extract (AGE; brand name Kyolic) is made by soaking garlic slivers in alcohol for 20 months, removing most allicin, and leaving an infusion high in antioxidant capacity. An RCT with 65 patients examined the impact of AGE (250 mg/d) and multivitamins on subclinical atherosclerosis. After 1 year, those in the AGE group had significantly better results than the control group for cognitive markers, vascular function, and progression of atherosclerosis. Another RCT found that people taking 960 milligrams AGE had considerably more reduction in systolic blood pressure (by 10.2 mmHg; P = 0.03).21 However, the total number of clinical studies assessing AGE remains small.
Garlic and its elements have been found to affect platelet aggregation and other aspects of blood clotting. Fibrinolysis leads to the breakdown of blood clots, and this process is promoted by various types of garlic preparations. Platelet aggregation has been beneficially affected by garlic in a small number of clinical trials. However, the Agency for Healthcare Research and Quality evaluation concluded that these results must be taken as preliminary. While most of the studies identified for this evaluation had beneficial outcomes, the studies were all very modest, of limited duration, and some had flaws.
Garlic is well-known for its problematic breath and body odor after oral ingestion. These are the most commonly reported complaints from trial participants. Eating raw garlic and high doses of some supplements can cause mouth and gastrointestinal irritation, heartburn, nausea, vomiting, and diarrhea. Some individuals are also vulnerable to allergic reactions, one study estimated that 1 percent of people are prone to allergic reactions from garlic.
The effects of garlic on platelet aggregation and fibrinolysis may raise the risk of bleeding, but that is mostly theoretical. While few studies or case reports have found such adverse consequences, individuals taking anticoagulants, those scheduled for an invasive process, or those with bleeding problems must be aware of this possible adverse effect. Some case reports of postoperative bleeding have been reported. But a randomized, controlled trial detected no change in bleeding events among individuals taking warfarin when given both garlic (AGE formula) or placebo. In vitro investigations have identified enzymes whose activities are impacted by aged garlic extracts. These results raise concerns that garlic might interfere with the metabolism of various drugs and medications. Though patients didn’t possess decreased serum levels actual interactions have been reported.
Overall, garlic preparations have some significance as a complementary agent in reducing some risk factors related to cardiovascular disease, or CVD. The evidence in studies indicated a range of benefits, but a number of these studies had small numbers of participants, have been of short duration, or had other methodological weaknesses. Higher-quality studies have found more limited benefits. Reductions in blood pressure, triglycerides, and total cholesterol are identified in meta-analyses. Several other effects have been discovered with research. Given its good safety profile, garlic may offer some protection from cardiovascular diseases, according to the research studies and conclusive data. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
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